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Recurrent Miscarriage (Green-top Guideline No. 17)

Published: 19 June 2023

The guideline provides comprehensive information on risk factors, recommended investigations and treatments for recurrent first trimester and one or more second trimester miscarriages.

It also discusses provisions for the management of any subsequent miscarriages, in terms of women and people receiving appropriate supportive care via informed and empathetic communication with healthcare professionals, ultrasound examinations and prompt access to services.

This guideline defines recurrent miscarriage as three or more first trimester miscarriages, in keeping with previous versions. However, clinicians are encouraged to use their clinical discretion to recommend extensive evaluation after two first trimester miscarriages, if there is a suspicion that the miscarriages are of pathological and not of sporadic nature. Furthermore, as the incidence of certain diagnoses does not appear to differ between women with consecutive versus non-consecutive losses, the definition in this guideline has not been restricted to women and people suffering with consecutive miscarriages only nor miscarriages suffered with the same partner, as certain maternal pathologies would be unaffected by the partner.

To conclude, areas of uncertainty are highlighted along with recommendations for future research in this field.

COVID disclaimer

This guideline was developed as part of the regular programme of Green-top Guidelines, as outlined in our document Developing a Green-top Guideline: Guidance for developers, and initiated prior to the emergence of COVID-19.

Version history

This is the fourth edition of this guideline.

Please note that the information provided in this update will be considered for update by the RCOG Guidelines Committee 3 years after publication, with an intermediate assessment of the need to update 2 years after publication.

Developers’ declarations of interest

Available on request.

This page was last reviewed 19 June 2023.